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General NPI Number Information
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NPI Number | 1801405329
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Entity Type | Individual
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Provider Name | SANDRA BURT NP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 6228 BRADLEY PARK DR STE A
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City | COLUMBUS
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State | GA
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Zip | 31904-3605
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Country | US
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Telephone | 706-322-1486
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Fax | 706-324-3419
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Provider Business Mailing Address
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Address Line | 6228 BRADLEY PARK DR STE A
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City | COLUMBUS
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State | GA
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Zip | 31904-3605
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Country | US
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Telephone | 706-322-1486
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Fax | 706-324-3419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN112087
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License Number State | GA
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